Document Detail


The Fontan procedure in the absence of the interatrial septum. Failure of its principle?
MedLine Citation:
PMID:  6855261     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The Fontan principle, defined as a procedure in which the right ventricle is bypassed in order to convey desaturated venous blood from the right atrium to the lungs, is presently applied for a wide variety of congenital heart malformations including those in which there is no suitable ventricular pumping chamber. Recently, the procedure has also been advocated for complex malformations that require atrial septation or intra-atrial rerouting. The present report evaluates our experience in four patients with such complex malformations. Three had a complete form of atrioventricular septal defect with double-outlet right ventricle and one patient had left atrioventricular valve atresia. The common atrium was morphologically right in two patients and morphologically left in one. In each of these instances anomalous pulmonary venous connections were present, together with abnormal systemic venous connections. The results were unsatisfactory. Three of the four patients died. The only survivor had no pulmonary or systemic venous abnormalities. Severe impairment of pulmonary blood flow was one of the most important postoperative complications. The findings suggest that the complexities of rerouting the blood within the atria play an important role. The excess proportion of prosthetic material to atrial myocardium may result in excessive loss of contractile atrial myocardium and, probably equally significant, in a complex intra-atrial geometry of pathways that may cause a critical pressure gradient. The results clearly show that with an expanding horizon of the application of the Fontan principle, new pitfalls may arise which presently appear to be the prevailing factors limiting its success.
Authors:
D Di Carlo; C Marcelletti; A Nijveld; L J Lubbers; A E Becker
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  85     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1983 Jun 
Date Detail:
Created Date:  1983-07-08     Completed Date:  1983-07-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  923-7     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Heart Atria / surgery*
Heart Septal Defects, Atrial / surgery*
Heart Septal Defects, Ventricular / surgery
Heart Valves / abnormalities,  surgery
Humans
Male
Methods
Postoperative Complications
Pulmonary Circulation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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